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Non-Custom Splinting Options
174 Plays3 days ago
Miranda and Josh talk about off the shelf splints
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Transcript
Introduction to Ham Therapy Academy
00:00:05
josh MacDonald
Hi, I'm Josh McDonald.
00:00:07
Miranda Materi
And I'm Miranda Maturi and we are Ham Therapy Academy.
Custom vs Non-Custom Splints
00:00:10
josh MacDonald
We're going to talk a little bit today about some alternative ways of splinting. We are big fans of custom splinting, thermoplastic material and strapping and maybe Orphacast and all these different custom things.
00:00:21
josh MacDonald
But there's also really good options that are not custom. So Miranda, do you have a go to non-custom, maybe prefab splint that you use frequently?
00:00:31
Miranda Materi
um There are a couple of things that I use frequently. One is the ovalates. I think it's really hard to make custom oval eights that fit well. So I like using oval eights.
00:00:42
Miranda Materi
Another thing is the cool comforts with or without the thermoplastic piece. It just depends. um And then of course I love like the wrist widget, I think. So those are probably my off the shelf go-to options.
Insurance & Accessibility Solutions
00:00:56
Miranda Materi
How about you?
00:00:57
josh MacDonald
Yeah, i I agree on all of those. We we use those a ton. I would say wrist widget more than um the comfort cools. I feel like I use those more before. And when I present patients with the options, just so few people pick that one.
00:01:11
josh MacDonald
I got a box full of rights and lefts, and I just haven't gone through a bunch. um I don't, honestly, I feel like the time that I rely on off the shelf more is when patients have They don't have insurance or they have an insurance that's going to cost them too much out of pocket for risk support for carpal tunnel or something like that. And I take them to a couple of links that we found on Amazon because they change their links sometimes.
00:01:35
josh MacDonald
One or two that's like, hey, here's an off the shelf for $15. That's a perfectly good. You'll have it tomorrow kind of option for patients when they just can't swing whatever the restrictions are on getting a custom fabricated splint.
00:01:51
Miranda Materi
Yeah, I agree with you definitely on that one. I think like there's not always like for mild or moderate carpal tunnel. I think someone you can order off of Amazon works just as well. And you can even get them where they have a little bit of a lumber call block.
00:02:02
Miranda Materi
And so in those cases, I'm like, well, um might as well just show you this link instead of, you know, billing your insurance, the whatever it is.
00:02:08
josh MacDonald
Yeah, yeah.
00:02:10
Miranda Materi
It just seems like the right thing to do. So I think in that instance, I will do
Transparency with Patients
00:02:14
Miranda Materi
that. However, I'll say if you don't like this or you need something more custom or your doctor wants something custom, then we'll do that for you.
00:02:20
josh MacDonald
Yeah, yeah, yeah. um And sometimes I'll have a doctor that just hands them an off the shelf and they get to me and they hate it. And so we'll do kind of the opposite and say, hey, listen, this is what your insurance would cover for this and it's what you're responsible. If you want, we can do a custom, but no pressure. If you're happy with what you've got, we kind of leave the ball in their court. So.
00:02:37
Miranda Materi
Yeah, I think being transparent about all the options, right? Because sometimes people come in and they don't know what their options are. So I like to be very transparent and tell them you can do A, B, or C. These are what I know of that's available. These are the costs of each one. and this is how much...
00:02:52
Miranda Materi
It'll cost with your type of insurance and then let them make the decision from there. And usually they'll even have samples in the clinic where they can try them on and and see what's what would work best for them. And then of course I offer my two cents and what ones I think people typically like and what would
Value of Custom Fittings
00:03:07
Miranda Materi
work best.
00:03:07
josh MacDonald
Yeah, yeah, absolutely. If I'm telling someone to do the Amazon option, like they're not going to buy one from, ah do the custom from us. That's totally fine. If it's a cost thing or whatever, I'll, I'll encourage them get two or three from Amazon when they show up at your house.
00:03:23
josh MacDonald
figure out which one you like the best and return the other two. Like, cause you don't know how exactly it's going to fit or this one came and it was super bulky or this one came and it was too big. And so I tell them like buy a couple, you can always return them to go to Kohl's and do the return.
00:03:37
josh MacDonald
It's super easy. And then they don't have to wait another day, wait another day for the right one to come in.
00:03:41
Miranda Materi
Right. And then showing them what position to put the wrist in too, right? Like sometimes those have the metal bars in them and the wrist will be in the complete wrong position.
00:03:50
josh MacDonald
Yeah.
00:03:50
Miranda Materi
And we don't get to see that because we, if you, if they order it, we don't know. I'm always like, well, make sure your wrist is, you know, in this position, which is around like nine, I think it's supposed to be nine degrees extension. So, and then they don't know nine degrees, but I just show them what it looks like and then tell them to bring it back in if they have questions.
00:04:01
josh MacDonald
Yeah. Yeah. yeah
00:04:07
josh MacDonald
And it's really not hard to either bend it while it's in or take, usually take that metal piece out of the sleeve and make it little shift to a second. Kind of explain that to Same thing though. Come back in. I'll take two minutes and show this to you. And it's really not a big deal for us. Yeah.
00:04:19
josh MacDonald
Yeah.
00:04:19
Miranda Materi
Yeah.
Exosplints & Clinic Applications
00:04:20
Miranda Materi
And I think getting them in the right thing is the most important thing. so
00:04:23
josh MacDonald
Yes. Yeah. Let's talk about exosplints. That's kind of a pseudo custom where they put it in the little oven and bake it and then they put it on the patient. They got the little click wire tension device.
00:04:34
josh MacDonald
We worked at a practice, both of us, where they started to use those more heavily. Do you still see those come through your clinic very often?
00:04:41
Miranda Materi
No, not very often. And I think the thing that is kind of a shame is they're building they're billing an L code, right? So they're building the same code that we would build for a custom when it's more semi-custom, right?
00:04:52
josh MacDonald
Yeah, yeah.
00:04:53
Miranda Materi
So I think it's unfortunate that that's happening. And I don't really see them anymore. Do you?
00:04:59
josh MacDonald
I haven't seen them in a while. I feel like the there are two places that i worked that used them and I haven't been to those places in a while. So I don't know if they're still using them, but I haven't seen one walk into the clinic in
3D Printing in Splinting
00:05:10
josh MacDonald
a while. um I feel like it's something that is kind of ah like a surgeon's practice thing to do so they can build that L code, but still have a supply in stock and a tech to apply them without it being a therapist. And yeah.
00:05:23
Miranda Materi
Yeah. I think some of the, I think there's some advantages to those. So I don't want to just say all the bad things about them, but i think a disadvantage they're harder to reform or make fully customizable. Cause there are lot of them are more circumferential.
00:05:34
Miranda Materi
So you're doing, you're getting a small, medium or large, right? So they're fitting you on those three.
00:05:37
josh MacDonald
yeah
00:05:39
Miranda Materi
So they're not really cut to fit each individual. You're just kind of put in a size grouping.
00:05:42
josh MacDonald
yeah
00:05:44
josh MacDonald
And they're going to block the distal palmar crease a little bit because it's it's hard to get that distal palmar crease free. And so you're limiting fingers a little bit. But if that's the only thing the patient's insurance will cover and that's all they get, then it's better than having nothing for sure.
00:06:00
Miranda Materi
Right. And then the other thing is if it's, we've all worked with some really great cast technicians, right? But it's not a therapist applying it. So a lot of times they might not know like, oh, I know I'm putting the wrist in nine degrees extension. I know the MCPs need to be free.
00:06:16
Miranda Materi
Like I think there's like all those little nuances that we do as hand therapists. And that's why we have that advanced credential because we like we look at everything in these micro details, right?
00:06:25
josh MacDonald
Yeah, yeah.
00:06:25
Miranda Materi
Versus if you're, and not say, I'm not saying that all cast texts are like that, but you really have to know what you're doing. i feel like to get the most appropriate bit. And I think that's the advantage of having a hand therapist put on a cast, whether be a semi-custom or totally custom one.
00:06:40
josh MacDonald
Yeah, yeah, yeah. Or even ah a delta cast, like knowing the the casting methodology to to give as much freedom of the joints that don't need to be involved as not. Yeah, yeah.
00:06:49
Miranda Materi
Right.
00:06:50
josh MacDonald
So let's talk a little about 3D splinting. I'm sorry, 3D printing, the 3D printing option for splinting. um I haven't had firsthand experience with a 3D printer and the whole 3D scanning process, but I have seen some splints come in that were fabricated that way.
00:07:07
josh MacDonald
I have some reservations about it. What exposure have you had?
00:07:10
Miranda Materi
um I would say similar to you, I've had patients bring them in I've sent, you know, people to get, we had one gentleman who was doing the 3D splinted oval eights and that was really cool.
00:07:22
Miranda Materi
I think it is definitely has a lot of potential for the future. I think it's knowing the right type of plastics because some of them can have like really sharp edges um and things like that. So I think, I think we will continue to see it more.
00:07:35
Miranda Materi
I think, um it's just i almost wonderful all eventually have like 3d printers in our clinic at one point where we just put in the information they printed out i think there's a lot of disadvantages that where the technology is not there yet and i think it's the length of time it takes to print something right so we'd have to like go measure the patient put in their data or scan them and then print it i think the printing takes a long time
00:07:59
josh MacDonald
And the ability to adjust it later down the road isn't there at least yet. And maybe that's something that will come if they can do it out of a temperature sensitive plastic, but um the ability, if edema changes, if um if they discover that they've got some sensitivity around the ulnar styloid, sometimes we'll make a custom splint pad thoroughly around someone's prominent ulnar styloid and still have to go back and bubble that out more. Like we planned for it and it still wasn't quite enough.
00:08:25
josh MacDonald
And so some of those things you can't yet do on three d printing when it's printed, it's printed. So does insurance cover for a second if there's a change in edema?
00:08:33
Miranda Materi
Yes. yes
00:08:34
josh MacDonald
Yeah, that's, I don't think that's quite there yet.
00:08:35
Miranda Materi
Yeah, there's a lot of those things. And I don't think it'll take ever take the place of custom s splinting. I think there's just incidents like where I thought where like there's one patient I'm always making a relative motion splint on. She comes in at least like twice a year where I'm remaking the exact same splint and getting it perfect for her each time because she'll be like, I really love this last one. Can you make that the same?
00:08:57
Miranda Materi
You're like, well,
Future Technologies in Splinting
00:08:58
Miranda Materi
kind of, but it's custom. So it's not going to be exactly the same. And I so wished in that instance, I just had a file Cause you know, she, she has a chronic condition that's not changing. So she doesn't have fluctuations in it. It's not like an acute injury where she has fluctuations in her edema or anything like that.
00:09:13
Miranda Materi
It's a chronic condition where she has an um RMO splint that she's going to wear for the rest of her life. So it's like, it would be really nice to be able to just click a button and send it to her.
00:09:20
josh MacDonald
Yeah.
00:09:23
josh MacDonald
Yeah. Yeah. i I've had those patients and I wish the same thing. I could do a copy paste and it's, oh, you made the perfect one last time. Just do it the same. I'm like, I don't remember what I did last time. So let's just make a new one and hope you like it as much.
00:09:37
Miranda Materi
Yeah, or they'll bring in the like, I like this. So you can see the material, you can see it, but also, you know, it's just really hard to replicate custom splint.
00:09:44
josh MacDonald
Yeah, yeah, it is for sure. Well, there's all kinds of options out there. And like we talked about, sometimes it's about patient affordability. Sometimes it's about what insurance does or doesn't doesn't cover. Some of our insurance plans don't cover splints at all, and they're on their own for it.
00:09:58
josh MacDonald
um Sometimes it's just advancing technology and keeping up with things out there. But um it's good to keep abreast of what's happening in the in the field and making sure that, you know, we're at least aware of what's coming of what's coming down the pike.
00:10:09
Miranda Materi
Yeah.
Community Engagement
00:10:10
Miranda Materi
So if you want to share your non-custom splinting options with us or any of your 3D printing tips, we'd love to hear them. Please email us info at hand therapy academy or reach out on Instagram at hand therapy academy.